High-Sensitivity Troponin I and Incident Coronary Events, Stroke, Heart Failure Hospitalization, and Mortality in the ARIC Study
High-Sensitivity Troponin I and Incident Coronary Events, Stroke, Heart Failure Hospitalization, and Mortality in the ARIC Study
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DOI：
10.1161/circulationaha.118.038772
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发表时间：
2019-06-04
期刊：
影响因子：
37.8
通讯作者：
Ballantyne, Christie M.
中科院分区：
文献类型：
--
作者：
Jia, Xiaoming;Sun, Wensheng;Ballantyne, Christie M.
背景技术背景：我们在一个没有心血管疾病病史的社区样本中，评估了通过高灵敏度测定（hs-TnI）测量的血浆肌钙蛋白I是否与心血管疾病（CVD）事件和死亡率相关。方法：ARIC研究（社区动脉粥样硬化风险）参与者年龄在54至74岁之间，基线时无CVD（n= 8121）。构建考克斯比例风险模型，以确定hs-TnI与冠心病（CHD;心肌梗死和致死性CHD）、缺血性卒中、动脉粥样硬化性CVD（CHD和卒中）、心力衰竭住院、总体CVD（动脉粥样硬化性CVD和心力衰竭）和全因死亡率之间的相关性。还评估了hs-TnI和高敏肌钙蛋白T与CVD事件的比较相关性。构建风险预测模型，以评估将hs-TnI添加到合并队列方程中使用的传统风险因素时的预测改善。结果：中位随访期为15年。在85%的研究人群中观察到可检测的hs-TnI水平。在调整模型中，与低hs-TnI相比（最低五分位数，hs-TnI = 1.3 ng/L），hs-TnI升高（最高五分位数，高敏肌钙蛋白I = 3.8 ng/L）与更高的冠心病发病率相关（风险比[HR]，2.20; 95% CI，1.64-2.95），缺血性卒中（HR，2.99; 95% CI，2.01-4.46），动脉粥样硬化性CVD（HR，2.36; 95% CI，1.86-3.00），心力衰竭住院（HR，4.20; 95% CI，3.28-5.37）、总体CVD（HR，3.01; 95% CI，2.50-3.63）和全因死亡率（HR，1.83; 95% CI，1.56-2.14）。观察到hs-TnI与白色人的总体CVD事件的关联性强于黑人，与女性CHD事件的关联性强于男性。高敏肌钙蛋白I和高敏肌钙蛋白T仅中度相关（r= 0.47），在预测CVD事件中具有互补性，与单独升高任何一种肌钙蛋白相比，两种肌钙蛋白升高的风险最高。在合并队列方程模型中加入hsTnI改善了对动脉粥样硬化性CVD、心力衰竭和总体CVD的风险预测。结论：在一般人群中，高敏肌钙蛋白I升高与全球CVD发病率增加密切相关，与传统风险因素无关。hs-TnI和高灵敏度肌钙蛋白T提供互补而非冗余信息。
BACKGROUND: We assessed whether plasma troponin I measured by a high-sensitivity assay (hs-TnI) is associated with incident cardiovascular disease (CVD) and mortality in a community-based sample without prior CVD. METHODS: ARIC study (Atherosclerosis Risk in Communities) participants aged 54 to 74 years without baseline CVD were included in this study (n= 8121). Cox proportional hazards models were constructed to determine associations between hs-TnI and incident coronary heart disease (CHD; myocardial infarction and fatal CHD), ischemic stroke, atherosclerotic CVD (CHD and stroke), heart failure hospitalization, global CVD (atherosclerotic CVD and heart failure), and all-cause mortality. The comparative association of hs-TnI and high-sensitivity troponin T with incident CVD events was also evaluated. Risk prediction models were constructed to assess prediction improvement when hs-TnI was added to traditional risk factors used in the Pooled Cohort Equation. RESULTS: The median follow-up period was 15 years. Detectable hs-TnI levels were observed in 85% of the study population. In adjusted models, in comparison to low hs-TnI (lowest quintile, hs-TnI = 1.3 ng/L), elevated hs-TnI (highest quintile, hs-TnI = 3.8 ng/L) was associated with greater incident CHD (hazard ratio [HR], 2.20; 95% CI, 1.64-2.95), ischemic stroke (HR, 2.99; 95% CI, 2.01-4.46), atherosclerotic CVD (HR, 2.36; 95% CI, 1.86-3.00), heart failure hospitalization (HR, 4.20; 95% CI, 3.28-5.37), global CVD (HR, 3.01; 95% CI, 2.50-3.63), and all-cause mortality (HR, 1.83; 95% CI, 1.56-2.14). hs-TnI was observed to have a stronger association with incident global CVD events in white than in black individuals and a stronger association with incident CHD in women than in men. hs-TnI and high-sensitivity troponin T were only modestly correlated (r= 0.47) and were complementary in prediction of incident CVD events, with elevation of both troponins conferring the highest risk in comparison with elevation in either one alone. The addition of hsTnI to the Pooled Cohort Equation model improved risk prediction for atherosclerotic CVD, heart failure, and global CVD. CONCLUSIONS: Elevated hs-TnI is strongly associated with increased global CVD incidence in the general population independent of traditional risk factors. hs-TnI and high-sensitivity troponin T provide complementary rather than redundant information.